Epithelial-myoepithelial carcinoma with high-grade transformation of parotid gland: A case report and literature review

Epithelial myoepithelial carcinoma of the parotid gland with high-grade transformation

A woman presented with a painless swelling in front of her right auricle, which, on examination, seemed to be a hard, immobile mass arising from the right parotid gland. CT scan showed a heterogeneously enhancing mass lesion in the superficial lobe of the parotid gland with partial extension into the deep lobe. Fine needle aspiration cytology suggested a high-grade transformation (HGT) with the presence of bizarre tumour cells. She underwent a right-sided total parotidectomy with transient facial neuropraxia in the postoperative period. The final pathological diagnosis of the specimen came out to be epithelial myoepithelial carcinoma with HGT, which is a relatively rare entity, with no defined guidelines for management. Our patient was managed by surgical resection alone without any postoperative radiation therapy, and short-term follow-up results seem to suggest no recurrence.

Epithelial-Myoepithelial Carcinoma of the Maxilla Arising From Minor Salivary Glands of Hard Palate: A Rare Case Report

Epithelial-myoepithelial carcinoma is a rare malignant neoplasm of salivary glands. It is specifically found in the major salivary glands. The cases that emerge from minor salivary glands are rarely described. Histologically, it commonly exhibits a characteristic biphasic pattern consisting of epithelial and myoepithelial components. The histopathological resemblance to other benign and malignant neoplasms that also display myoepithelial characteristics makes the differential diagnosis challenging. Each differential diagnosis requires a very different management approach. Considering the difficulties of anatomopathological diagnosis and the rarity of epithelial-myoepithelial carcinomas emerging from minor salivary glands, we report a rare epithelial-myoepithelial carcinoma case of minor salivary glands in a 58-year-old woman. She was referred for a palatal swelling, evolving for more than 35 years, and reported recent pain and nasal obstruction. The mucosal swelling was located in the left maxilla within the hard palate, of a 45-mm-long axis crossing the medial line and extending to the premaxilla, without cervical lymph node involvement. A computed tomography scan revealed a palatal lesion involving the left and the right maxilla. Furthermore, the superior alveolar process, both left and right maxillary sinuses, the nasal cavities, and the nasal septum were included in the lesion. The final diagnosis was difficult to confirm despite multiple biopsies and was determined only from the excised specimen. The diagnosis of this tumor was challenging due to the clinical and histological similarities with other salivary tumors. The aim of this case report is to shed light on the distinctive features of these tumors and explore optimal screening and related management strategies.

A rare case of epithelial-myoepithelial carcinoma arising ex pleomorphic adenoma of the lacrimal gland: case report and review of the literature

A 92-year-old man presented with progressively worsening eye pain, diplopia on lateral gaze and blurred vision for the past 12 months. Radiological imaging confirmed a large left lacrimal gland lesion. The patient subsequently underwent a superio-lateral orbitotomy with left dacryoadenectomy and tumor removal, histopathology subsequently confirmed an epithelial-myoepithelial carcinoma arising ex pleomorphic adenoma of the lacrimal gland. Epithelial-myoepithelial carcinoma is a rare lacrimal gland tumour and the authors believe this case to be the first reported in the Australian population and associated with prolonged eye pain.

Epithelial-myoepithelial carcinoma ex pleomorphic adenoma of the parotid gland with unique histologic differentiation: A rare case report

Epithelial myoepithelial carcinoma (EMC) is an uncommon low-to-intermediate grade salivary gland malignancy that accounts for 1% of all tumors arising in salivary glands. About 80% of these tumors affect the parotid gland. These lesions either arise de novo or from existing pleomorphic adenoma (PA). Histologically, these tumors reveal a biphasic cell population with inner ductal epithelial cells and peripheral myoepithelial cells. There are many histologic variants of EMC, but sebaceous, verocay-like differentiation and high-grade transformation is very rarely reported. This article describes a 48-year-old female patient diagnosed with EMC ex PA with unique histologic differentiation.

Metastatic Carcinoma to the Right Heart: The Complementary Utility of Contrast-Enhanced Echocardiography and Cardiac Positron Emission Tomography/Computed Tomography

•

Metastatic tumors are >40 times more common than primary cardiac tumors.

•

Parotid gland tumors rarely metastasize to the heart.

•

TTE is the initial test of choice to evaluate for cardiac metastases.

•

Contrast TTE is not contraindicated in patients with advanced CKD.

•

Contrast TTE can assist in differentiating benign from malignant cardiac masses.

Pulmonary epithelial-myoepithelial carcinoma (P-EMC) with focal high grade transformation: Molecular and cytologic findings

BACKGROUND

Pulmonary epithelial-myoepithelial carcinoma (P-EMC) is a rare type of salivary gland tumor of the lung. Diagnosis from preoperative biopsies or fine needle aspiration (FNA) cytology specimens is difficult given the rarity of the tumor and overlapping cytomorphology with other entities. These tumors generally have a good prognosis, however prior reports of recurrence and metastasis to lymph nodes have been reported. Further, little is known about the malignant potential of high grade transformation. The molecular characteristics of this entity are unknown, with only a few case reports commenting on molecular findings. Here, we report a case of P-EMC with focal high grade transformation. We present its diagnostic pitfalls on cytology specimens, surgical pathology, immunohistochemistry, and molecular findings.

CASE PRESENTATION

A 72 year old female presented with an incidentally detected lung mass. A chest computed tomography (CT) demonstrated a left hilar mass measuring 4.1 cm with endobronchial extension into the left upper lobe. On the initial endobronchial core needle biopsy and cytology FNA, the tumor was misinterpreted as squamous cell carcinoma. The patient subsequently underwent a left pneumonectomy along with mediastinal lymph node dissection. Final surgical pathology of the resection specimen indicated a P-EMC with focal high grade transformation. The patient is disease-free 1 year post-surgery.

CONCLUSIONS

Due to the rarity of P-EMC, insufficient sampling and histologic heterogeneity, diagnosis of P-EMC on preoperative core needle biopsy or FNA specimen is difficult. Herein, we present a rare case of P-EMC, with a pre-operative FNA cytology specimen that consisted of tumor cells with dense cytoplasm and moderate cytologic atypia, strong positive staining pattern of p40, that was misdiagnosed as squamous cell carcinoma. Follow up surgical resection showed P-EMC with focal high grade transformation. Salivary gland EMCs with high grade transformation have previously been reported to have a worse prognosis, however, little is known about the malignant potential in the lung. Next generation sequencing (NGS) using a 397-gene solid tumor panel identified variants in DNMT3A, APC, STAT3 in both low and high grade components, while KDM5C was present only in the high grade transformation.

Epithelial-myoepithelial carcinoma of the parotid gland with primary lung cancer: A rare case report

INTRODUCTION

Epithelial-myoepithelial carcinoma (EMC) is a rare, low-grade malignancy that occurs primarily in the parotid gland and is most common in women aged 60 to 70 years. Cases of parotid EMC have been reported previously. Furthermore, some studies have suggested an increased risk of salivary gland tumors with secondary primary malignancies. There have been few reports of parotid EMC with other primary tumors.

PATIENT CONCERNS

A 62-year-old Chinese man visited the hospital with a complaint of a mass on his left cheek that had persisted for 20 years. Routine pulmonary computed tomography showed a local ground glass shadow in the lower lobe of the right lung.

DIAGNOSIS

The pathological diagnosis of lung was right lower lobe lung adenocarcinoma (pT1N0). Immunohistochemistry analysis showed that cytokeratin (CK)-7, NapsinA, and thyroid transcription factor-1 tested positive, while CK5/6, P40, and ALKD5F3 tested negative. The pathological diagnosis of left parotid gland: EMC. On immunohistochemistry staining, the outer cells expressed myoepithelial markers, such as CK5/6, P63, smooth muscle actin, while the inner cells expressed glandular epithelial markers, such as low-molecular-weight CK7 and CK8.

INTERVENTIONS

The patient underwent resection of the lung and parotid tumors, and received preventive radiotherapy in the parotid gland area.

OUTCOMES

The patient is in good condition. No symptom recurrence, distant metastatic spread or significant toxicity occurred during or after the treatment. The patient remains under regular surveillance.

CONCLUSION

We report a rare case of parotid EMC with a second primary lung adenocarcinoma. This case is the third case of primary lung cancer associated with parotid EMC reported to date and the first to be reported in nearly 30 years.

Radiation-associated epithelial-myoepithelial carcinoma among five secondary malignancies: A case report and review of literature

BACKGROUND

Epithelial-myoepithelial carcinoma (EMC) is a rare, low-grade, malignant tumor that constitutes less than one percent of all salivary gland tumors. To date, only one other case report has described radiation-associated EMC in the English language medical literature.

CASE SUMMARY

In this report, we describe the case of a 56-year-old male patient who presented with a neck mass diagnosed as EMC of the left submandibular gland approximately 30 years after mantle field radiation and chemotherapy for Hodgkin lymphoma. Treatment included resection, re-resection with nodal dissection, and adjuvant chemoradiotherapy. This patient was also diagnosed with 4 other secondary malignancies, including stage IV diffuse large B cell lymphoma in the abdomen with subsequent brain metastases, low-grade neuroendocrine carcinoma of the lung, Hurthle cell adenoma, and small B cell lymphoma before the patient expired. This case provides important information regarding the pathology, clinical sequelae, and management of a patient diagnosed with radiation-associated EMC amidst four concurrent malignancies.

CONCLUSION

Further investigation is needed on the efficacy of adjuvant radiotherapy in EMC, especially atypical EMC.